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Permit (65) CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2017-00304 and OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 05/10/2017 GA RD 9 Parcel: SEG841 Jurisdiction: Tigard Site address: Project: Traffic Signal Subdivision: Lot: Project Description: (1)200 amp service for new traffic signal on the NW corner of 135th at Walnut St. Contractor: NORTHSTAR ELECTRICAL CONTRACTORS Owner: 19450 SW CIPOLE RD, STE 107 TUALATIN, OR 97062 PHONE: 503-612-0840 PHONE: FAX: 503-612-0891 FEES Quantity Description Date Amount Specifics: 1 ea Services or Feeders-200 05/04/2017 $100.70 amps or less 1 ea 12%State Surcharge- 05/04/2017 $12.08 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTI•6 : -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 . rough OAR •52-001-000900.. You may obtain a copy of the rules or direct questions to OUNC by calling 50987 or 1.800.332.2344. �j2C. Issue By: Permittee Signature: • �' ,.x,:,21 Vir," OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' 1 ,AY 4e9—t------ Date: 6-/e, LICENSE NO. O S 3 S Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Applicat C FOR OFFICE USE ONLY v City114 Of Tla6"C Received 4 13125 SW Hall Blvd.,Tigard,OR 972'3 R 2 6 2017Date/B -� J�/ Pen"�t:Ete� 7-470.,S0 a Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Related Permit#: Date1B ( IICaARD Inspection Line: 503.639.4175 CI1'Y OFrIGARD Ready Date/By; inns: B1 See Page 2for Internet: www,tigard�i.g�ovE ��`�+ �t'hi`�kP Notified/Method: Supplemental Information GD�YAf� PLAN REVIEW li New construction 0 Addition/alteration/replacement Please check all that apply(submit 1 sets of plans wiitems checked): 0 Demolition 0 Service or feeder 400 amps or more 0 Building over three stories. Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at I50 volts or 0 Floating buildings. o 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. © Multi-family 0 Master builder ®Other: ❑Firer„i, p p ❑Installation afl50lCUAor JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#:8846 Job site address:SW WALNUT&SW 135TH AVE ❑Addition of new motor load of system; 1OOHP or more. ❑`A"."E","l 2„,"l_3'•, City/State/ZIP:TIGARD s272,6-t-r-5 C/11dr- il'l// 0 Six or more residential units. occupancy. ❑Health-care Facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:WALNUT-116TH TIEDMAN 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site:SW WALNUT&SW 135TH AVENUE FEE SCHEDULE Description I On. l Each I Total I ; New residential single-or multi-family dwelling unit. Subdivision: Lot#' Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 l DESCRIPTION OF WORK Limited energy,residential SERVICE FOR NEW TRAFFIC SIGNAL (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) 0PROPERTY OWNER 1 0 k ETT' Renewable Energy 0 See Page 2 .... Services or feeders installation,alteration,and/or relocation Name: 200 amps or less I 100.70 100.70 2 Address: 201 amps to 400 amps 133.56 2 City/State/ZIP: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email` Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 0`APPLICANTp CONTACT PERSON Branch circuits-new,alteration,or extension,•er panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7`42 2 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Phone: Miscellaneous(service or feeder not included) ( ) Fax: :( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:NorthStar Electrical Contractors Sign or outline lighting 67.84 2 Address:9130 SW Pioneer Court,Suite A Signal circuit(s)or limited energy SPe 2 2 panel,alteration,or extension. ee age City/State/ZIP:Wilsonville,OR 97070 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)612-0840 Fax:(503)612-0891 Investigation(1 hr rain) 90.00/hr Email:marilyn.achtermani@northstarelect,com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: 90454 y/Z //ilectrical Lie 34-359c Suprv.Lie.: 5853S specifically listed(4 hr min) ill ELECTRICAL PERMIT FEES Suprv. Electrician signature,'required: Subtotal: 100.70 Print name: Jesse N.Culp Date: 04/26/2017 0 Plan Review Required(25%of permit fee): ff State surcharge(12%of permit fee): 12.08 Authorized signature: f Ij TOTAI.PERMIT FEE: 112.78 4 This permit application expires if a permit is not obtained within 180 Print name: Jesse N.Culp Date: 04/26/2017 days after It has been accepted as complete. * Number of inspections allowed per permit. t:1Building1Permits\ELC_PermitApp ELR_ERE.doc.Rev1)5/I7/2015 440-4615T(Il/Q5/COMWED City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: Record Type: Record ID: Commercial - Electrical ELC2017-00304 Inspection Type: Inspector: 115 Electrical service Jeff Grove Result: PASS Comments: Violation Summary: Inspector Contractor